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Master Thesis

Characteristics and outcomes of patients with ophthalmologic involvement in giant-cell arteritis: a case-control study

Abstract : Purpose: To describe the characteristics and outcome of patients with giant-cell arteritis (GCA)related ophthalmologic involvement at diagnosis. Methods: In a retrospective single-center cohort of 409 consecutive patients with GCA, we retrieved 104 patients with visual symptoms at GCA diagnosis and we compared them to 104 age- and sexmatched controls without ophthalmologic involvement. Each visual symptom was associated to an ophthalmologic diagnosis that was centrally re-assessed by an ophthalmologist. Results: Compared to controls, patients with visual symptoms showed less fever (p=0.0006), less polymyalgia rheumatica (p=0.02) and lower acute phase reactants (p=0.004). Blurred vision (in 60% of patients), amaurosis fugax (in 18%), diplopia (in 13%) and permanent visual loss (in 9%) were the four visual symptoms described by patients before GCA diagnosis. Anterior ischemic optic neuropathy (AION) was found in 47 (45 %) patients, followed by central retinal artery occlusion (CRAO) in 15 (15%). Two patients had both involvements. The delay of glucocorticoids initiation was not different between patients with and without visual symptoms (p=0.06). Among the 60 patients with initial AION and/or CRAO, 39 (65%) kept definite blindness or important visual damage, although 45 (75%) had received intravenous (IV) pulses of methylprednisolone. A new ischemic event (AION in all cases) occurred in 4% of patients with visual symptoms despite the initiation of treatment. Conclusion: Ophthalmologic involvement was observed in one-quarter of our GCA patients. AION is still associated with the worst visual prognosis, and IV methylprednisolone pulses did not reduce the risk of blindness in our study.
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Submitted on : Tuesday, February 11, 2020 - 11:07:24 AM
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Anaël Dumont. Characteristics and outcomes of patients with ophthalmologic involvement in giant-cell arteritis: a case-control study. Human health and pathology. 2019. ⟨dumas-02474167⟩

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